Insurance Application


ONLINE KYC FORM APPLICATION





Corporate Entity
Contact Person
Banking Details
Declaration of Beneficial Ownership

The company hereby confirms and declares that as at the date hereof, the following individual(s) is/ are the ultimate principal beneficial owner(s) of the company through ownership in the intermediate or ultimate holding companies.

Fullname Residential Address Date of Birth Nationality Percetange of Ownership

ANTI-MONEY LAUNDERING AND COUNTER TERRORIST FINANCING REQUIREMENTS

In accordance with the financial Intelligence Regulations the following documents should be provided for verification.

Natural Person

- Identification documents e.g Certified copy of ID/Passort.

Company

- Certificate of Incorpation

- Memorandum and Article of Association

- Notice of Registered Office and Postal Address

- Identification Documents of person(s) managing the company

- Resolution specifying who is authorised to act on behalf of the company

- Identification Documents of person(s)authorised to act on behalf of the company

Partnerships

- Partnership Agreement

- Identification Documents of person(s) who are partners e.g Certified copy of ID/Passort.

- Resolution specifying who is authorised to act on behalf of the Partnership

- Identification Documents of person(s)authorised to act on behalf of the Partnership

DECLARATION

I hereby declare that the details furnished above are true and correct for the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately. In case of the above information is found to be false or untrue or misleading or misrepresenting, I am aware i may be liable for it.